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Neonatal Med > Volume 18(2); 2011 > Article
Journal of the Korean Society of Neonatology 2011;18(2):272-279.
DOI: https://doi.org/10.5385/jksn.2011.18.2.272    Published online November 25, 2011.
Risk Factors Associated with Gastrointestinal Tract Colonization by Enterobacteriaceae in Neonatal Intensive Care Unit Patients.
Min Ji Kim, Yu Jin Jung, Yoo Rha Hong, Il Kwon Bae
1Department of Pediatrics, Kosin University Gospel Hospital, Busan, Korea. pondhong@gmail.com
2Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.
The incidence of nosocomial infection caused by Gram-negative bacilli (GNB) has increased in neonatal intensive care units (NICU). This study identified the progression of sepsis caused by GNB colonization and analyzed the risk factors associated with using periodic stool culture surveillance.
We included 86 newborns admitted to the NICU, Kosin University Gospel Hospital from October 2007 to May 2008. Three stool specimens were collected right after birth and two more were collected at 2 week intervals. The risk factors related to GNB colonization were established from each medical record and related references.
The incidence of colonization by GNB was 22 (25.6%) per 86 neonates but none had culture-proven sepsis. The three most commonly isolated GNB were Pseudomonas aeruginosa, Enterobacter cloacae, and Citrobacter freundii. Approximately 89% (32/36) of isolated GNB were susceptible to amikacin. The probability of GNB colonization increased in infants who were fed a small volume during enteral feeding. In contrast, delayed enteral feeding resulted in a decreased probability for GNB colonization.
Colonized GNB in the intestine was confirmed by enteric surveillance culture of newborns admitted to the NICU. However, we found no evidence of culture-proven GNB sepsis. As lower feeding volume on the colonization day is a risk factor for GNB colonization, the chance for GNB colonization should be considered when feeding intolerance is present.
Key Words: Enterobacteriaceae, Colonization, Neonatal intensive care unit


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